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Original Investigation
April 29, 2021

Associations of Baseline Frailty Status and Age With Outcomes in Patients Undergoing Vestibular Schwannoma Resection

Author Affiliations
  • 1School of Medicine, New York Medical College, Valhalla, New York
  • 2Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
  • 3Department of Neurosurgery, University of New Mexico School of Medicine, Albuquerque
  • 4Division of Otolaryngology–Head and Neck Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City
  • 5Division of Otolaryngology–Head and Neck Surgery, Department of Surgery, University of New Mexico School of Medicine, Albuquerque
  • 6Department of Neurosurgery, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey
  • 7Department of Neurosurgery, New Jersey Medical School, Rutgers University, Newark
  • 8Department of Neurosurgery, Johns Hopkins Medicine, Baltimore, Maryland
  • 9Department of Neurosurgery, Westchester Medical Center, Valhalla, New York
JAMA Otolaryngol Head Neck Surg. Published online April 29, 2021. doi:10.1001/jamaoto.2021.0670
Key Points

Question  What are the independent prognostic associations of chronological age and frailty (physiological age) with outcomes following vestibular schwannoma (VS) resection?

Findings  In this population-based, cross-sectional analysis of outcomes following VS resection, an assessment of 27 313 patients using the National Inpatient Sample demonstrated that mortality and extended hospital lengths of stay were independently associated with increasing frailty and not with increasing age.

Meaning  Although these findings warrant prospective validation, frailty may be more accurate for predicting surgical outcomes and guiding treatment decisions than advanced patient age alone following VS resection.


Importance  Although numerous studies have evaluated the influence of advanced age on surgical outcomes following vestibular schwannoma (VS) resection, few if any large-scale investigations have assessed the comparative prognostic effects of age and frailty. As the population continues to age, it is imperative to further evaluate treatment and management strategies for older patients.

Objective  To conduct a population-based evaluation of the independent associations of chronological age and frailty (physiological age) with outcomes following VS resection.

Design, Setting, and Participants  In this large-scale, multicenter, cross-sectional analysis, weighted discharge data from the National Inpatient Sample were searched to identify adult patients (≥18 years old) who underwent VS resection from 2002 through 2017 using International Classification of Diseases, Ninth Revision, Clinical Modification and Tenth Revision, Clinical Modification codes. Data collection and analysis took place September to December 2020.

Main Outcomes and Measures  Complex samples regression models and receiver operating characteristic curve analysis were used to evaluate the independent associations of frailty and age (along with demographic confounders) with complications and discharge disposition. Frailty was evaluated using the previously validated 11-point modified frailty index (mFI).

Results  Among the 27 313 patients identified for VS resection, the mean (SEM) age was 50.4 (0.2) years, 15 031 (55.0%) were women, and 4720 (21.0%) were of non-White race/ethnicity, as determined by the National Inpatient Sample data source. Of the included patients, 15 090 (55.2%) were considered robust (mFI score = 0), 8204 (30.0%) were prefrail (mFI score = 1), 3022 (11.1%) were frail (mFI score = 2), and 996 (3.6%) were severely frail (mFI score ≥3). On univariable analysis, increasing frailty was associated with development of postoperative hemorrhagic or ischemic stroke (odds ratio [OR], 2.44 [95% CI, 2.07-2.87]; area under the curve, 0.73), while increasing age was not. Following multivariable analysis, increasing frailty and non-White race/ethnicity were independently associated with both mortality (adjusted OR [aOR], 2.32 [95% CI, 1.70-3.17], and aOR, 3.05 [95% CI, 1.02-9.12], respectively) and extended hospital stays (aOR, 1.54 [95% CI, 1.41-1.67], and aOR, 1.71 [95% CI, 1.42-2.05], respectively), while increasing age was not. Increasing frailty (aOR, 0.61 [95% CI, 0.56-0.67]), age (aOR, 0.98 [95% CI, 0.97-0.99]), and non-White race/ethnicity (aOR, 0.62 [95% CI 0.51-0.75]) were all independently associated with routine discharge.

Conclusions and Relevance  In this cross-sectional study, findings suggest that frailty may be more accurate for predicting outcomes and guiding treatment decisions than advanced patient age alone following VS resection.

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